CFS, Chronic Fatigue syndrome

Clinic

• Also called myalgic encephalomyelitis (ME) or ME/CFS
• It is a complex, debilitating, Long-term medical condition with Unknown causes and mechanisms.
• Lengthy exacerbations or flare-ups of the illness following ordinary minor physical or mental activity, known as post-exertional malaise (PEM); greatly diminished capacity to accomplish tasks that were routine before the illness; and sleep disturbances.
• Orthostatic hypotention
• Cognitive dysfunction

Signs and symptoms

• Main
  • Fatigue which last six months or longer.
  • Physical or mental activity agg
  • Sleep problems; people may still feel weary after full nights of sleep, or may struggle to stay awake, fall asleep or stay asleep.
  • Brain fog: Problems with thinking and memory
  • Orthostatic intolerance

• Others
  • Muscle pain, joint pain without swelling or redness, and headache
  • Tender cervical lymphadenopathy
  • Sore throat
  • Chills and night sweats
  • Allergies to foods, odors, chemicals, lights, or noise
  • Shortness of breath
  • Irregular heartbeat
  • Increased sensitivity to sensory stimuli and pain

Related disease

• Irritable bowel syndrome
• Fibromyalgia
• Interstitial cystitis
• Chronic pelvic pain syndrome

Cause

• Because it may begin as an influenza-like illness with a sudden onset, various infectious causes have been proposed, but evidence is insufficient to prove such causation.
• Infections proposed include mononucleosis, Chlamydophila pneumoniae, HHV-6, and Lyme disease
• Often, the illness will follow a viral illness such as mononucleosis or gastroenteritis.

• EBV

• CMV
• VZV

Pathophysiology

• Brainstem hypometabolism

• Autonomic nervous system dysfunction has a role in CFS
• have been observed in CFS.
• Evidence points to abnormalities in HPA axis.

Entities

CFS entities	EBV	HIV	HSV-1	CMV
Mononucleosis Tender cervical lymphadenopathy Sore throat	+++	+++		+++
Syncope/ Orthostatic hypotension			+++	+++
Adrenal insufficiency	+++		++	+
Depression	++		++
Fatigue
Central sensitization

Recent researches

• An association between CFS and abnormalities of the HPA axis has been described, and other adrenal steroid abnormalities have been suggested.
• DHEA and its sulphate (DHEA-S), apart from being a precursor of sex steroids, have other functions associated with memory, depression and sleep.
  • It has been suggested that CFS may be associated with a state of relative DHEA(-S) deficiency.
  • Therefore we investigated basal levels of DHEA(-S), the cortisol/DHEA molar ratio and the responsiveness of DHEA to stimulation by CRH.
• Recent studies have also suggested that low dose hydrocortisone may be effective at reducing fatigue in CFS. We therefore also assessed these parameters prior to and following treatment with low dose oral hydrocortisone.
• DHEA levels are raised in CFS and correlate with the degree of self-reported disability.
• Hydrocortisone therapy leads to a reduction in these levels towards normal, and an increased DHEA response to CRH, most marked in those who show a clinical response to this therapy.
• Note that in PCOS, we have also high level of DHEA.

Entity

• Syncope: RBS, SAHF, LSSV, YF, CXA-B, HSV-1, TBE
• Depression:EBV, B19, HSV-1, PLV, HBV, RBOL
• Central sensitization: DHF, PLV, HSV-1, HSV-2, CLTV, LSSV

Miasmatic analysis

HSV-1

Remedies

• Lach

Am-c

• Poor memory,
• Weakness and exhaustion,
• Headache,
• Throat pain and enlarged cervical glands.

Arn

• Sufferers often complain of feeling as if they’ve been beaten up. Arnica corresponds to an aggravation from exertion, recurring fever, joint pain and a headache as from a nail being driven into the head. Arnica may benefit in this case from alternation with Hypericum. Arsenicum album Great prostration with mental weakness and burning pains, characterise this remedy. Alternating restlessness and exhaustion with anxiety, joint and muscle pain, weakness from exertion, fever, insomnia and restless sleep, headache and a swollen and painful throat may be seen here. Beryllium Occasionally useful where there is weakness with slight fever and symptoms are worse from physical exertion. A headache and sore throat may also be seen here. Calc carb Obesity, head sweats and coldness are often seen in those who find this remedy useful. Complaints are worse from exertion and there is muscular weakness, poor memory, poor sleep, headache, intermittent fever, joint pain, sore throat and swollen cervical glands. Calc phos It’s often noted that in those needing Calc phos, their complaints are worse when thinking about them. Relevant symptoms that may be noted include weakness and fatigue, poor memory, poor concentration, joint pain, sore throat, and a headache in the occiput or near the sutures. Camphor Characterised by a feeling of coldness in the body, yet they cannot bear to be covered, the Camphor type may also exhibit extreme exhaustion, poor memory, a mainly occipital headache, fever and a sore throat. Carbo animalis The symptoms here include swollen and indurated lymph glands, great weakness, a headache that feels as if the skull was being blown apart and night sweats. Carbo veg The applicability of this remedy is often indicated by a desire to be constantly fanned. There may also be poor memory, weakness of the extremities, an occipital headache and a sore throat. China China types with this condition are often very sensitive to touch and this may coexist with debility, night sweats, muscle pain, insomnia, joint pain and a throbbing headache. There’s often a marked periodicity of symptoms with this remedy. Hypericum Poor memory, headache, joint pain and ailments that are worse from exertion may be seen in those who have a need for this remedy. Iris versicolor Iris v. is often thought of clinically for migraine headaches, and for CFS will be useful where there’s fatigue with irritability, mental exhaustion from overwork, a sore throat and memory weakness. Kali phos Nervous prostration often prompts thoughts of Kali phos. Where this occurs with fatigue with trembling, restless sleep, occipital headaches and muscle fatigue upon exertion, Kali phos can be very useful. It is best used in taking the case forward rather than curing it. Lachesis Those who will respond to this remedy often exhibit ailments that begin on the left side and then move to the right. In CFS sufferers, look for poor memory, headache with pressure or burning of the vertex, difficulty sleeping, swelling of the axillary glands and a sore throat. Nux vomica Oversensitive, angry or irritable are words often used to describe the person who requires this prescription. Fatigue with irritability caused by overwork, a frontal or occipital headache, sore throat, joint pain, muscle tension and sleeping difficulties will help to confirm the utility of Nux vomica in CFS. Onosmodium Another small remedy that’s occasionally indicated, especially when accompanied by left-sided migraine, muscular weakness and sleeplessness. Phosphorus A client mentioning a craving for ice cold drinks and food may prompt thoughts of Phosphorus. Specific CFS symptoms that may also indicate the need for it include debility which is worse from exertion, loss of memory, a headache over one eye, sore throat and sleeplessness. Phosphoric acid The symptoms that correspond to Phos Ac include listlessness and apathy, emotional and physical exhaustion, poor memory, difficult concentration, a headache in thetemples and vertex, joint pain and a low grade fever. Picric acid Those needing this remedy may be heard to complain of feeling worn out mentally and physically, they feel exhausted after the least exertion, especially mental exertion and may also suffer from sleeplessness and occipital headaches. Scutellaria Nervous fear and restlessness may be seen here and those symptoms specifically indicating a need for Scutellaria in CFS include ailments worse from overexertion, poor concentration, disturbed sleep and frontal headaches. Silica Defective nutrition and its related ailments often characterises the need for this remedy. Specific CFS symptoms seen here include exhaustion caused by overwork, poor memory, glandular swelling, “sick” headache over usually settling over one eye and restless sleep. Stannum met A weakness of the chest is often seen here, as is weakness from the slightest exertion, headache or migraine felt in the frontal or temple area, night sweats and a sore throat. Sulphuric acid Like many of the acid remedies, fatigue and exhaustion are frequently experienced by the person needing Sulphuric acid. Restless sleep, a sore throat and a headache of the occiput or right temple may help to guide the prescriber to this remedy. Tuberculinum The Tuberculinum type is often emaciated and takes cold easily. They may suffer from a poor memory, weakness, night sweats, joint pains, swollen glands, periodic headaches extending from the right eye to the left ear, insomnia and a sore throat. Most symptoms, including weakness, are aggravated by the slightest exertion. Zincum met Zincum met is often considered where there is restlessness of feet or legs. This remedy type also exhibits a poor memory, mental exhaustion, sleeping difficulties, weakness, headache felt in the occiput or temples, poor sleep and a sore throat.